glaxosmithkline in china case study

China and Corruption: The Case of GlaxoSmithKline

By: Conner Lee

GlaxoSmithKline (GSK) is Britain’s biggest drug maker. Chinese authorities found GSK guilty of bribing both hospitals and doctors to help promote their products in China, using a network of nearly seven hundred travel agencies to pay medical professionals, health-related organizations, and government officials. According to Chinese authorities, GSK funneled about 3 billion yuan, or US$482 million, through this network to recipients. Receipts were forged for purchases and transactions that never took place, including fake conferences. At first, GSK denied any involvement in the bribes. Then, after an internal investigation, GSK admitted that certain executives acted independently in ways that broke Chinese law. (Rajagopalan) Chinese television even went so far as to air an alleged confession of one of the four senior GSK executives under investigation of how the scheme relied on “fake conferences and travel agencies to create receipts for services that were never performed.” (Thompson) GSK denies the sums of money are as high as Chinese officials suggest.

The Chinese officials also seemed to emphasize how the cost of the bribes was passed directly to Chinese consumers. In other words, doctors and other medical staff were bribed to sell their products and the cost of those bribes was added to the price of the products that consumers paid for. In some cases, the final price of the product was several times the cost in other countries. (BBC News) Chinese officials also claim GSK bribed officials to obstruct Chinese investigations, according to a security ministry official. (Bloomberg)

Five senior executives of GSK were arrested and subsequently found guilty of bribery. Mark Reilly, the chief executive of GlaxoSmithKline operations in China, received a suspended prison sentence. Four other GSK managers in China received similar suspended sentences. GSK’s local subsidiary in China was found guilty of bribery and fined nearly US$500 million, the largest corporate fine in China, according to the official Chinese news agency Xinhua. While the total fine is large, it is dwarfed by GSK’s annual free cash flow of about £4 billion. The company is also being investigated in other countries, and faces allegations that it bribed doctors in “Poland, Iraq, Jordan, and Lebanon.” (Rajagopalan) GSK wants to be the “The first company in the drugs industry to stop paying outside doctors to promote its products.” (Rajagopalan) It also claims to want to stop company policies that incentivize sales representatives to bribe doctors, and end payments for medical professionals to attend conferences. (Rajagopalan) In addition, since GSK was accused of bribery, its sales in China have taken a hit as well, and may be down permanently. In 2013, GSK’s sales dropped thirty percent after it was accused of corruption. (Financial Times) Once one of GSK’s fastest-growing markets, GSK’s medicine and vaccine sales, dropped 61% in the country, and sales of its consumer health products dropped by 29%. (Jack)

Corruption in China

China in the middle of a growing anti-corruption program, a program initiated by Chinese President Xi Jinping (Shobert). Cases of corruption used to be rare; however, due to public discontent with corruption in the Chinese Communist Party, the government was forced to respond. Announcements of investigations of party officials and businesses are now constantly in China’s headlines. (First Source from Hatton)

Corruption is a serious problem in China; even low-level officials can easily make small fortunes. Party officials can make millions of dollars a year in bribes and blackmail. The family of the official who launched the anti-corruption campaign, according to Bloomberg, holds an estimated $376 million. (Second Source from Hatton) In 2013, China was ranked 80 th out of 178 countries in the Transparency International’s Corruption Perceptions Index . Corruption is widely believed to be one of the major barriers to China’s social and economic development; some analysts warn that corruption threatens the country’s future and the popularity (and power) of the Communist Party. The Chinese public views corruption as a major problem. Many citizens in surveys say it is the biggest problem the country faces. Citizens describe corruption as unrestricted and rapidly growing. According to some estimates, approximately 10 percent of Chinese government funding is used as bribes, kickbacks, or is stolen. Even when investigations take place, the likelihood of corrupt officials going to jail is less than three percent. (Pei)

Anticorruption attempts have largely been failures in China. It is hard to enforce laws and regulations when everyone is breaking them. However, it is also possible the Western media has a false perception of how bad corruption is in China. As one source notes, “Between 1979 and 2000, over 700,000 cases for investigation were filed against officials by investigators.” Of these, approximately 56 percent of such cases were embezzlement, 28 percent bribery, and misuse of public funds 16 percent. If this is true, then it is possible the Chinese government may be doing more than it seems to confront corruption. (Manion, 87)

Corruption in China increased dramatically after 1978, and has grown hand-in-hand with the economy. As one source notes, “The Chinese economy has, it would seem, flourished even as corruption worsened.” (Wedeman, 4) Some nations are able to succeed despite high levels of corruption, and China seems to be one such country. (Wedeman, 4) Many authors seem to agree that while corruption and rapid growth may coexist together in the short-term, they are essentially contradictory. While the steps the Chinese government has taken to curtail corruption may have been ineffective, it is possible these efforts have prevented corruption from spiraling out of control. (Wedeman, 8)

China’s Healthcare System

China is in the midst of reforming its health care system, which is being expanded at a rapid pace. This includes a new national health insurance plan, which covers basic health needs. Unfortunately, these additions are “Being built on a top of a very weak foundation.” “Doctors are chronically over-worked and under-paid” (Shobert), working long hours and earning far too little. In addition, hospitals are stuck between fund shortages and rising health-care costs. Consequently, alternative means of revenue have been found. In this case, doctors seem to be making up for low salaries with bribes, as seen in cases such as the GSK scandal. In addition, Chinese citizens often bribe health care professionals to ensure that they receive good treatment when needed. (Shobert)

There are several major forms of corruption in the Chinese health-care system. The first is the pricing system. The government has laws on how much hospitals can charge for various products and services, but hospitals often simply ignore these laws, setting their own prices or simply overbilling patients. (Tam, 267) There have been several cases in which hospitals have charged patients for care they did not receive. Hospital staff at all levels were found to be accepting bribes, from patients that expect better medical services to medical equipment and pharmaceutical firms hoping to sell their products. Doctors, especially, accept bribes often. (Tam, 268) Hospitals have been documented to sell patients cheaper fake and substandard medications, illegally charging them the cost of the real medication and then pocketing the difference. Hospitals reap vast profits this way, especially in medical departments that treat serious illness, such as oncology. (Tam, 269)

The medical industry is stuck between rising expenses and declining budgets. China has a desperately underfunded public health care system. Between 1985 and 2005, government spending as a percentage of total health-care spending dropped from an estimated 38.6% to 17.9%. Health expenditure by private organizations declined as well. Meanwhile, personal spending on health care increased, from 20.4% in 1978 to 52.2% in 2005. Hospitals are forced to make up for the difference using illicit income to cover their expenses. (Tam, 270, 272)

Many health-care professionals use corruption as a means for personal gains. Loopholes and lax enforcement of law worsen the problem. One way in which physicians gain personal profit is by prescribing drugs and medical procedures that patients do not need. Sometimes part of the money paid for the medicine is kicked back to the physician. (Tam, 273) Doctors who are found accepting bribes are rarely penalized (Tam, 274), authorities who are aware of the budgetary problems the health care system faces are often unwilling to confront corruption.

Competition in the Chinese health-care system is intense, and many pharmaceutical firms resort to bribery and corruption as a means of selling their products. Chinese firms typically spend twenty to thirty percent of the price of their products on bribing doctors and hospitals, and customers are forced to pay the costs of these bribes. (Tam, 274)

The problems in the health industry have diminished public trust in the hospital systems. Various surveys indicate that many patients feel they must bribe doctors to ensure they receive good care. Otherwise, they fear poor treatment within the health care system. This sentiment cannot be understated. (Tam, 277)

Many foreign companies complain that, “China is broadly becoming a less hospitable place for multinational companies to operate.” (Shobert) Many foreign firms are convinced they are being scrutinized by regulatory oversight, and they are being held to higher regulatory standards than their domestic counterparts. If these suspicions are in fact true, then domestic firms in China are likely behaving far worse than their foreign competitors. (Shobert)

Public pressure for reform in the health-care industry is growing. A backlash threatens to undermine the Chinese government, and public resentment regarding corrupt officials in the industry is growing. While past attempts to deal with corruption in the industry have fallen short, it is possible the government may eventually be forced to deal with the problem. For instance, in 2006, 2,000 people rioted outside a hospital after a three-year old boy died of ingesting pesticide. The doctors there had refused to treat the boy because the parents did not have cash on hand when they arrived at the hospital. According to some estimates, there were about 17,000 such incidents in 2010. Officials have good reason to fear a public backlash. It is also possible that reform attempts will fall apart as in the past.

Since the scandal, China has passed several bills aimed at dealing with corruption in the health-care industry. The National Health and Family Planning Commission issued two bills with “anti-corruption compliance requirements” (Ross and Zhou), as well as a “blacklist” of certain medical-device firms and pharmaceutical companies that have violated the law. Chapter 49 establishes “Nine prohibitions” aimed at preventing bribery in the health-care sector. These prohibitions are aimed at preventing institutions and individuals from accepting various types of bribes and cutbacks, including preventing medical personnel from accepting commissions or kickbacks of any kind from medical institutions other than the one they work at. Chapter 50, however, establishes a blacklist system that shuts firms and individuals who have participated in bribery out of the health-care system. The last attempt at doing this was a 2007 law that was ineffective, and this new law aims to be much more effective. These bills are now law. (Ross and Zhou)

The GlaxoSmithKline Case

The case that GlaxoKlineSmith bribed Chinese officials does have merit. The company itself has acknowledged that there seems to have been some misconduct by certain executives, so it is almost undeniable the bribery took place. There is another side to this case, however. Bribery and other forms of corruption are not just common in China, companies are actually expected to bribe simply as a way of business. In many hospitals, all of the staff can be expected to be involved in the bribery system. It is so common there are literally systems in some hospitals to divide the profits from the bribes.

GSK was wrong in participating in the bribery schemes. It also was wrong in participating in corruption even if it was following expected industry norms in the country. It is never ethical to do a wrong act (in this case bribery) even if everyone else is doing the same act.

Given that large numbers of foreign companies complain of being unfairly scrutinized by Chinese authorities, it is likely the Chinese government unfairly investigated GSK because it was a large, foreign company with rapid market share growth that threatened domestic industry. Because bribery is so common, and because everyone does it, the Chinese government has the power to pick winners and losers. The government can arrest and press charges against any company it does not like, and rightfully claim the company was in violation of the law. GSK, in particular, was targeted for being a big, foreign firm with high market share growth in China.

Ultimately the consequences of the bribery scandal had a net negative impact on many people especially patients who carried most of the cost of corruption. The bribes caused many doctors to prescribe certain medications when they should have prescribed others, and it’s caused certain patients to receive better treatment than others. Corruption also vastly undermined public trust in the Chinese health care system, with most of the public deeply skeptical of hospitals and physicians. Unfortunately, bribery and corruption are the only ways that the Chinese health care system gets the funding it needs. Without bribery and other such forms of illegal funding, the Chinese health care system would either go bankrupt or go into debt. But bribery doesn’t just affect the people who have direct association with the act. It affects the behavior of a large segment of society. Even when everyone else is doing something bad, doing the action yourself only makes the problem worse. In the case of GlaxoSmithKline, the consequences of bribery actually contribute in undermining society, making the act unethical.

Works Cited:

Jack, Andrew, Patrick Jenkins, and David Oakley. “GlaxoSmithKline China Sales Face Growing Pressure – FT.com.” Financial Times . Financial Times LTD, 23 Sept. 2013. Web. 18 July 2014.

Shobert, Benjamin. “Three Ways To Understand GSK’s China Scandal.” Forbes . Forbes Magazine, 04 Sept. 2013. Web. 25 June 2014.

Rajagopalan, Megha, and Kazunori Takada. “Chinese Police Charge British Former Head of GSK in China with Bribery.” Reuters . Thomson Reuters, 14 May 2014. Web. 24 June 2014.

“UK Executive Accused in GlaxoSmithKline China Probe.” BBC News . BBC, 14 May 2014. Web. 25 June 2014.

“Glaxo’s Former China Head Accused of Ordering Bribes.” Bloomberg.com . Bloomberg, 14 May 2014. Web. 25 June 2014.

Insider, The. “The Glaxo-China Bribery Scandal: A New Policeman Walks The Beat.” Forbes . Forbes Magazine, 25 July 2013. Web. 25 June 2014.

Thompson, Mark. “Bribery Scandal Will Hit Glaxo’s China Growth.” CNNMoney . Cable News Network, 24 July 2013. Web. 25 June 2014.

(First Source from) Hatton, Celia. “How Real Is China’s Anti-corruption Campaign?” BBC News . BBC News, 4 Sept. 2013. Web. 25 June 2014.

(Second Source from) Hatton, Celia. “How Serious Is China on Corruption?” BBC News . BBC News, 28 Jan. 2013. Web. 25 June 2014.

Pei, Minxin. “Corruption Threatens China’s Future.” Carnegie Endowment for International Peace . Carnegie Endowment, 9 Oct. 2007. Web. 25 June 2014.

Ross, Lester, and Kenneth Zhou. “China’s New Anti-Corruption Policies in the Health Care Industry.” Wilmerhale . Wilmer Cutler Pickering Hale and Dorr LLP, 9 Jan. 2014. Web. 25 June 2014.

Tam, W. “Organizational Corruption By Public Hospitals In China.” Crime Law And Social Change 56.3 (n.d.): 265-282. Social Sciences Citation Index . Web. 25 June 2014.

Jack, Andrew. “GSK China Sales Plummet 60% since Scandal – FT.com.” Financial Times . The Financial Times LTD, 23 Oct. 2013. Web. 25 June 2014.

Manion, Melanie. Corruption by Design: Building Clean Government in Mainland China and Hong Kong . Cambridge, MA: Harvard UP, 2004. Print.

Wedeman, Andrew Hall. Double Paradox: Rapid Growth and Rising Corruption in China . Ithaca: Cornell UP, 2012. Print.

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Curbing Corruption: GlaxoSmithKline in China

British pharmaceutical company GlaxoSmithKline bribed its way into many hospitals in China, but Chinese regulators did not tolerate the company’s corruption.

Multinational companies have often turned to China with the prospect of marketing to a large population that has seen major economic growth in recent decades. As China has become an economic leader, the country has also invested more in its fight against corruption, in part to protect its own economy. British pharmaceutical company GlaxoSmithKline (GSK) discovered this firsthand when, in 2014, the company was fined $489 million by Chinese courts for bribing doctors and hospitals to use its products and bribing government officials and regulators to ease monitoring of GSK.

In 2013, an anonymous whistleblower sent an email to GSK board members, describing fraudulent activities in China. The whistleblower stated that medical professionals were given all-expenses-paid trips under the pretense of attending professional conferences. Also, the drug Lamictal was being heavily promoted as a treatment for bipolar disorder, despite being approved only for treatment of epilepsy by Chinese regulators. The whistleblower explained that GSK “almost killed one patient by illegally marketing its drug Lamictal,” and that “GSK China bought the patient’s silence for $9,000.” The whistleblower sent e-mails to GSK’s executives and auditor PricewaterhouseCoopers over the course of 17 months.

According to Chinese state media reports on the investigation, GSK apparently bribed government officials, gifting a Shanghai investigator an iPad and treating him to a $1,200 dinner. Reports also stated that Mark Reilly, the GSK country manager for the Chinese market, was given company funds for the purpose of bribing Beijing officials.

China first opened up its economy to international companies decades ago in order to help develop its own economy. Many multinational corporations avoided scrutiny over bribery as their presence helped establish manufacturing in China and created jobs. As Jerome Cohen, a legal advisor for international companies, explained, “For a long time, there’d been this policy of going easy on foreign enterprises,” adding, “The government didn’t want to cause embarrassment or give outsiders the impression that China is plagued with corruption. But they’re not thinking like that anymore.”

Extensive bribery by pharmaceutical multinationals is also a part of the massive expansion of the healthcare system in China. Benjamin Shobert, Senior Associate for International Health at the National Bureau of Asian Research, explained that new hospitals and infrastructure have been built at a rapid pace. However, according to Shobert, doctors are often overworked and underpaid and hospital administrators cannot always close the gap between government reimbursements and the growing costs of healthcare. He wrote, “It should be no surprise that both hospital administrators and doctors have found alternative means to make up for the revenue not provided by the government. For administrators, their response has been to incentivize doctors to prescribe unnecessary pharmaceuticals, surgical procedures, and diagnostic evaluations. Doctors have supplemented their paltry incomes through the sort of bribes the GSK scandal has laid bare.”

In addition to the fines faced by GSK, Reilly and four other managers were sentenced to prison time by the Chinese government. The charges against GSK have pointed to changes in other companies’ presence in China. For example, Microsoft faced scrutiny over antitrust allegations, Apple modified its tax practices after facing fines in China, and Disney has partnered more closely with Chinese producers. GSK apologized for its dealings in China and vowed to both reduce and change its interactions with Chinese healthcare professionals. CEO Andrew Witty stated, “We will also continue to invest directly in the country to support the government’s health care reform agenda and long-term plans for economic growth.”

Related Terms

Corruption is the dishonest conduct for personal gain by people in power.

Ethical Insight

Corruption is the abuse of power or position for personal gain. It often involves bribery, as in the case of British pharmaceutical company GlaxoSmithKline (GSK) in China. GSK bribed medical professionals to push their drugs into the market. The company also bribed government officials to ease up on regulation. Some patients were made ill because doctors were heavily motivated to prescribe drugs encouraged by GSK, not the drugs that were best for their patients, in order to reap the highest financial rewards for themselves. In an effort to curb corruption, the Chinese government levied large fines against the company and sent several company managers to prison.

Discussion Questions

1. Who is hurt by corruption and how?

2. How was corruption fostered for multinational companies in China? How was corruption later curbed?

3. How did GSK gain influence among government officials and healthcare workers?

4. As Jerome Cohen pointed out, China had a history of “going easy on foreign enterprises” until more recent efforts to curb corruption. If corruption is common in a country or in a particular industry, can it still be unethical? Do you think GSK was simply playing by the rules of a corrupt system? Why or why not? To what degree do you think companies have a responsibility to act ethically in a system that enables corruption?

5. Doctors and hospital administrators accepted bribes from GSK in part because they were underpaid. Do you think it was ethically justifiable for them to accept these bribes? Why or why not?

6. Because of its actions described above, GSK paid $20 million to settle civil charges under the Foreign Corrupt Practices Act. You can understand why China wishes to minimize bribery on its soil, but why might the U.S., U.K., or other countries that are home to multinational corporations such as GSK think they should be concerned about bribery happening elsewhere in the world?

7. Who should be responsible for regulating multinational companies operating in foreign markets? Companies, governments, or third-parties? Explain your reasoning and how these efforts might protect against corruption.

8. Can you think of other examples of corruption you have seen with your own eyes or read about or seen on TV? What happened? What were the consequences of corruption?

9. GSK’s case demonstrates the pitfalls of a number of biases and behaviors including the self-serving bias, ethical fading, and conformity bias. Can you identify other behavioral ethics concepts at work in this case study? Explain and discuss their significance.

Bibliography

China Fines GlaxoSmithKline $485 Million for Bribery http://time.com/3404140/china-fines-glaxosmithkline-bribery/

Drug Giant Faced a Reckoning as China Took Aim at Bribery https://www.nytimes.com/2016/11/02/business/international/china-rules-glaxo-bribes-sex-tape-whistleblower-cautionary-tale.html

Three Ways To Understand GSK’s China Scandal https://www.forbes.com/sites/benjaminshobert/2013/09/04/three-ways-to-understand-gsks-china-scandal/#4593ef3555dc

GlaxoSmithKline Found Guilty of Bribery in China https://www.wsj.com/articles/glaxosmithkline-found-guilty-of-bribery-in-china-1411114817

Former head of GlaxoSmithKline in China is accused of bribery http://www.latimes.com/business/la-fi-glaxosmithkline-china-bribery-20140514-story.html

The Glaxo-China Bribery Scandal: A New Policeman Walks The Beat https://www.forbes.com/sites/insider/2013/07/25/the-glaxo-china-bribery-scandal-a-new-policeman-walks-the-beat/#72943d7d7373

China Fines GlaxoSmithKline Nearly $500 Million in Bribery Case https://www.nytimes.com/2014/09/20/business/international/gsk-china-fines.html

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GlaxoSmithKline in China (A)

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Four GlaxoSmithKline employees were accused of bribing Chinese health care workers to prescribe the company's drugs. The accusations brought to light the questionable incentive structures of the…

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Four GlaxoSmithKline employees were accused of bribing Chinese health care workers to prescribe the company's drugs. The accusations brought to light the questionable incentive structures of the Chinese health care system and the pressure on companies to adhere to local customs while still observing local laws.

Learning Objectives

To explore why executives engage in bribery. To assess the crisis management capacity of a multinational company in an important, emerging economy.

Nov 7, 2013 (Revised: Sep 8, 2015)

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China, United Kingdom, United States

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Apparel accessories, Healthcare sector, Healthcare service industry, Insurance industry, Pharmaceutical industry, Public administration

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China Fines GlaxoSmithKline Nearly $500 Million in Bribery Case

By Keith Bradsher and Chris Buckley

Sept. 19, 2014

HONG KONG — Global multinationals have invested billions of dollars in China over the last decade, with the prospect of selling to 1.4 billion people. But the promise of China’s growth is increasingly offset by the dangers of being caught up in the country’s anticorruption campaigns and rising economic nationalism.

In the strongest signal yet, a Chinese court on Friday imposed a fine of nearly $500 million on the British pharmaceutical giant GlaxoSmithKline for bribery, dwarfing the penalties in earlier criminal cases.

Multinational companies broadly have been under pressure in China, with technology companies, automakers and food manufacturers under investigation. As new cases and penalties have emerged, companies have been nervously preparing for their own potential fallout.

Last week, Chinese authorities fined the Audi unit of Volkswagen $40.5 million for violations of antitrust laws. In a similar case, a dozen Japanese auto parts and bearing manufacturers were assessed $200 million in penalties last month.

Beijing officials have gone out of their way in the last two weeks to deny complaints by foreign business groups and governments that China’s continuing legal crackdown represents an effort to discriminate against multinational companies and help Chinese companies compete. The Glaxo case showed that “an open China is not a lawless one,” Xinhua, the official news agency, said in a commentary.

But the Glaxo case underlines the dangers for multinationals as they continue to do business in a country where corruption has been widespread and where the legal and regulatory system has shown a greater willingness to prosecute foreign companies.

Two antitrust lawyers involved in other cases said in separate interviews that Chinese officials had rushed investigations along, sometimes in a few weeks, with little chance for multinationals to present their side. In some antimonopoly cases this summer, multinational company executives have not even been allowed to bring their lawyers to meetings with regulators, the lawyers said, both of whom insisted on anonymity because they were representing clients in litigation.

In many cases, regulators demanded that multinationals sharply reduce prices for products. Glaxo and a growing list of automakers have already done so.

Few companies have faced the level of scrutiny that Glaxo has. But no other multinational has acknowleged that its senior managers oversaw such a spree of bribe-giving and illicit sales tactics.

Chinese authorities accused Glaxo of bribing hospitals and doctors, channeling illicit kickbacks through travel agencies and pharmaceutical industry associations — a scheme that brought the company higher drug prices and illegal revenue of more than $150 million. In a rare move, authorities also prosecuted the foreign-born executive who ran Glaxo’s Chinese unit.

After a one-day trial held in secrecy, the court sentenced Glaxo’s British former country manager, Mark Reilly, and four other company managers to potential prison terms of up to four years. The sentences were suspended, allowing the defendants to avoid incarceration if they stay out of trouble, according to Xinhua. The verdict indicated that Mr. Reilly could be promptly deported. The report said they had pleaded guilty and would not appeal.

Glaxo said in a statement that it “fully accepts the facts and evidence of the investigation, and the verdict of the Chinese judicial authorities.” “GSK P.L.C. sincerely apologizes to the Chinese patients, doctors and hospitals, and to the Chinese government and the Chinese people.”

The British Embassy in Beijing said that it had no information on the possible deportation of Mr. Reilly and that while an appeal remained possible, it would have no comment on the trial.

“We note the verdict in this case,” an embassy spokesman said. “We have continually called for a just conclusion in the case in accordance with Chinese law. It would be wrong to comment while the case remains open to appeal.”

The court said that in deciding how to punish Mr. Reilly, it had taken into account that he had returned from Britain to face the investigators, and that he had “truthfully recounted the crimes of his employer,” meriting a relatively lenient punishment, the Xinhua report said. The other defendants also confessed and also earned relatively light sentences, according to the report.

The Glaxo case — and sizable fine — represents a setback for the company.

When the accusations first emerged last year, the company said that employees were “outside of our systems of controls.” It said the scandal involved a few rogue Chinese-born employees.

But the case escalated in May, when Chinese police accused Mr. Reilly, a Briton, of orchestrating a “massive bribery network.” Mr. Reilly and two Chinese-born executives, Zhang Guowei and Zhao Hongyan, had even bribed government officials in Beijing and Shanghai, they said. The names of the other defendants are Liang Hong and Huang Hong.

In its statement, Glaxo said that the court, the Changsha Intermediate People’s Court, had found the company guilty only of bribing nongovernmental personnel. The statement made no mention of any conviction for bribing government officials, a more politically delicate issue as President Xi Jinping of China pursues a broad campaign to root out corruption.

The accusations sent a chill through the industry when they came out last year. Many global drug makers used the same Shanghai travel agency that the authorities in the Glaxo case said had altered corporate travel expenses to pay cash bribes.

“It’s very hard to do business in the Chinese health care and pharmaceutical sectors without doing payoffs,” said David Zweig, the director of the Center on China’s Transnational Relations at the Hong Kong University of Science and Technology. “Everyone else pays bribes. Glaxo just got caught.”

Glaxo has also loomed large over another case.

In August, business partners in the investigative firm ChinaWhys were sentenced by a Chinese court after they were hired by Glaxo to look into whether a former employee was passing information about suspicions of fraud at the company to Chinese authorities.

Glaxo hired the couple in spring 2013 to look into whether a former employee had sent the company emails and a sex video of Mr. Reilly recorded without his knowledge or consent, according to people who were briefed on the situation and spoke on the condition of anonymity. The video was recorded with a camera inside his Shanghai apartment bedroom.

ChinaWhys, which specialized in due diligence work , completed an inconclusive preliminary report on the sex video of Mr. Reilly by June 2013 and suggested continuing the inquiry. In July 2013, the couple was detained, and they were formally arrested a month later, accused of illegally obtaining private information for their company.

The couple’s family has said the arrests were almost certainly linked to the Glaxo investigation, adding that Glaxo had not told Peter Humphrey, one of the investigators, the full details of the person suspected of being a whistle-blower.

Mr. Humphrey was sentenced to two and a half years in prison. The other, his wife, Yu Yingzeng, who is a Chinese-born American citizen, was sentenced to two years. The court said Mr. Humphrey would be deported after he served his term.

Glaxo appeared to distance itself from ChinaWhys in its statement Friday evening, saying that, “GSK P.L.C. also apologizes for the harm caused to individuals who were illegally investigated by” one of its subsidiaries in China.

Jane Perlez contributed reporting from Beijing.

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China fines GlaxoSmithKline $492M for bribery

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BEIJING (AP) — Drug maker GlaxoSmithKline was fined $492 million on Friday for bribing doctors in China, the biggest such penalty ever imposed by a Chinese court.

The court sentenced the company’s former China manager, Briton Mark Reilly, and four Chinese co-defendants to prison but postponed the sentences for two to four years, suggesting they may never be served. The court said it granted leniency because the defendants confessed.

The case, first publicized in mid-2013, highlighted the widespread use of payments to doctors and hospitals by sellers of drugs and medical equipment in a poorly funded health system that Chinese leaders have promised to improve. The fine is the largest such penalty ever imposed by a Chinese court.

In a statement, Glaxo said it would pay the fine and had made changes in its business to remedy flaws cited by Chinese authorities. It said it would change the incentive system for employees and reduce its engagement with health professionals.

“Reaching a conclusion in the investigation of our Chinese business is important, but this has been a deeply disappointing matter for GSK. We have and will continue to learn from this,” said CEO Sir Andrew Witty in the statement.

While large by Chinese standards, the fine is dwarfed by the $3 billion GlaxoSmithKline agreed to pay the U.S. government in July 2012 for paying doctors kickbacks to prescribe several of its drugs and for having sales representatives promote popular drugs for improper uses. The penalty is still the biggest U.S. health care fine in history, according to the nonprofit group Taxpayers Against Fraud.

Reilly was sentenced by the court in the central city of Changsha to three years prison with a four-year reprieve and was ordered deported, which meant he might leave China immediately. His co-defendants received prison terms of two to four years, with reprieves of two to four years.

In other cases, convicts have been spared prison if they are deemed to have reformed during their reprieve.

The police ministry said in May that Reilly was accused of operating a “massive bribery network.” It said Reilly ordered salespeople beginning in January 2009 to pay doctors, hospital officials and health institutions to use GSK’s products.

A police investigation found that GSK employees funneled as much as 3 billion yuan ($490 million) through travel agencies and consulting firms, which kicked back some of that money for use as bribes. Police have not made clear how much was paid out in bribes.

Investigators said the scheme appeared to be aimed at evading GSK’s internal controls meant to prevent bribery.

Glaxo had said earlier the employees acted without its knowledge and violated its policy. In December, it said it would stop offering financial support to doctors and other health care professionals to promote its products.

Such informal payments pervade China’s dysfunctional health system. Low salaries and skimpy budgets drive doctors, nurses and administrators to make ends meet by accepting money from patients, drug suppliers and others. The Glaxo case brought the flow of illicit money to international attention, but within China the practice is common knowledge.

Many blame a system in which China’s hospitals nearly all are state-run but get too little money from Beijing. Most of the country’s 2.3 million doctors are hospital employees and are barred from adding to their income by taking on second jobs.

The ruling Communist Party has promised higher health spending as part of efforts to spread more of China’s prosperity to its poor majority. But with a population of 1.3 billion, the cost of a full-scale overhaul will be daunting.

A second foreign drugmaker, AstraZeneca, said in July 2013 that police in Shanghai were investigating one of its salespeople.

In a separate case, China’s biggest drug distributor, Sinopharm Group Ltd., said in January that two former executives were the target of a corruption investigation.

GlaxoSmithKline is among many multinational drugmakers that have crossed legal or ethical lines to boost sales of prescription medicines.

Most cases involve promoting prescription medicines for uses that aren’t approved — and for which there is often no evidence that they are effective or safe. Some drugs have grown to become multibillion-dollar annual sellers primarily from patients taking them for unapproved uses.

It was also common practice for decades for drugmakers to pay doctors in the U.S. and elsewhere “consulting fees,” send them on junkets and give them gifts, with the expectation that the doctors would prescribe more of that company’s medicines and even encourage colleagues to do so. The industry has attempted to eliminate or at least reduce those excesses under pressure from the government and others. Companies will soon begin publicly reporting payments to doctors, as required under provisions of the Affordable Care Act.

Business Writer Linda A. Johnson in Trenton, N.J., contributed to this report.

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Glaxosmithkline in china (b) description.

In 2013, Chinese investigators detained four GSK employees for allegedly bribing health care staff to sell GSK pharmaceuticals. A month later, GSK's Asia Pacific regional president, Abbas Hussain, said the company would help identify corrupt practices. Two days later, GSK's CEO, Andrew Witty, called the allegations "shameful" and said the company would use the opportunity to "make changes."

Case Description GlaxoSmithKline in China (B)

Strategic managment tools used in case study analysis of glaxosmithkline in china (b), step 1. problem identification in glaxosmithkline in china (b) case study, step 2. external environment analysis - pestel / pest / step analysis of glaxosmithkline in china (b) case study, step 3. industry specific / porter five forces analysis of glaxosmithkline in china (b) case study, step 4. evaluating alternatives / swot analysis of glaxosmithkline in china (b) case study, step 5. porter value chain analysis / vrio / vrin analysis glaxosmithkline in china (b) case study, step 6. recommendations glaxosmithkline in china (b) case study, step 7. basis of recommendations for glaxosmithkline in china (b) case study, quality & on time delivery.

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Case Analysis of GlaxoSmithKline in China (B)

GlaxoSmithKline in China (B) is a Harvard Business (HBR) Case Study on Sales & Marketing , Texas Business School provides HBR case study assignment help for just $9. Texas Business School(TBS) case study solution is based on HBR Case Study Method framework, TBS expertise & global insights. GlaxoSmithKline in China (B) is designed and drafted in a manner to allow the HBR case study reader to analyze a real-world problem by putting reader into the position of the decision maker. GlaxoSmithKline in China (B) case study will help professionals, MBA, EMBA, and leaders to develop a broad and clear understanding of casecategory challenges. GlaxoSmithKline in China (B) will also provide insight into areas such as – wordlist , strategy, leadership, sales and marketing, and negotiations.

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GlaxoSmithKline in China (B) case study solution is focused on solving the strategic and operational challenges the protagonist of the case is facing. The challenges involve – evaluation of strategic options, key role of Sales & Marketing, leadership qualities of the protagonist, and dynamics of the external environment. The challenge in front of the protagonist, of GlaxoSmithKline in China (B), is to not only build a competitive position of the organization but also to sustain it over a period of time.

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Texas Business School Approach to Sales & Marketing Solutions

In the Texas Business School, GlaxoSmithKline in China (B) case study solution – following strategic tools are used - SWOT Analysis, PESTEL Analysis / PEST Analysis / STEP Analysis, Porter Five Forces Analysis, Go To Market Strategy, BCG Matrix Analysis, Porter Value Chain Analysis, Ansoff Matrix Analysis, VRIO / VRIN and Marketing Mix Analysis. We have additionally used the concept of supply chain management and leadership framework to build a comprehensive case study solution for the case – GlaxoSmithKline in China (B)

Step 1 – Problem Identification of GlaxoSmithKline in China (B) - Harvard Business School Case Study

The first step to solve HBR GlaxoSmithKline in China (B) case study solution is to identify the problem present in the case. The problem statement of the case is provided in the beginning of the case where the protagonist is contemplating various options in the face of numerous challenges that Gsk's Gsk is facing right now. Even though the problem statement is essentially – “Sales & Marketing” challenge but it has impacted by others factors such as communication in the organization, uncertainty in the external environment, leadership in Gsk's Gsk, style of leadership and organization structure, marketing and sales, organizational behavior, strategy, internal politics, stakeholders priorities and more.

Step 2 – External Environment Analysis

Texas Business School approach of case study analysis – Conclusion, Reasons, Evidences - provides a framework to analyze every HBR case study. It requires conducting robust external environmental analysis to decipher evidences for the reasons presented in the GlaxoSmithKline in China (B). The external environment analysis of GlaxoSmithKline in China (B) will ensure that we are keeping a tab on the macro-environment factors that are directly and indirectly impacting the business of the firm.

What is PESTEL Analysis? Briefly Explained

PESTEL stands for political, economic, social, technological, environmental and legal factors that impact the external environment of firm in GlaxoSmithKline in China (B) case study. PESTEL analysis of " GlaxoSmithKline in China (B)" can help us understand why the organization is performing badly, what are the factors in the external environment that are impacting the performance of the organization, and how the organization can either manage or mitigate the impact of these external factors.

How to do PESTEL / PEST / STEP Analysis? What are the components of PESTEL Analysis?

As mentioned above PESTEL Analysis has six elements – political, economic, social, technological, environmental, and legal. All the six elements are explained in context with GlaxoSmithKline in China (B) macro-environment and how it impacts the businesses of the firm.

How to do PESTEL Analysis for GlaxoSmithKline in China (B)

To do comprehensive PESTEL analysis of case study – GlaxoSmithKline in China (B) , we have researched numerous components under the six factors of PESTEL analysis.

Political Factors that Impact GlaxoSmithKline in China (B)

Political factors impact seven key decision making areas – economic environment, socio-cultural environment, rate of innovation & investment in research & development, environmental laws, legal requirements, and acceptance of new technologies.

Government policies have significant impact on the business environment of any country. The firm in “ GlaxoSmithKline in China (B) ” needs to navigate these policy decisions to create either an edge for itself or reduce the negative impact of the policy as far as possible.

Data safety laws – The countries in which Gsk's Gsk is operating, firms are required to store customer data within the premises of the country. Gsk's Gsk needs to restructure its IT policies to accommodate these changes. In the EU countries, firms are required to make special provision for privacy issues and other laws.

Competition Regulations – Numerous countries have strong competition laws both regarding the monopoly conditions and day to day fair business practices. GlaxoSmithKline in China (B) has numerous instances where the competition regulations aspects can be scrutinized.

Import restrictions on products – Before entering the new market, Gsk's Gsk in case study GlaxoSmithKline in China (B)" should look into the import restrictions that may be present in the prospective market.

Export restrictions on products – Apart from direct product export restrictions in field of technology and agriculture, a number of countries also have capital controls. Gsk's Gsk in case study “ GlaxoSmithKline in China (B) ” should look into these export restrictions policies.

Foreign Direct Investment Policies – Government policies favors local companies over international policies, Gsk's Gsk in case study “ GlaxoSmithKline in China (B) ” should understand in minute details regarding the Foreign Direct Investment policies of the prospective market.

Corporate Taxes – The rate of taxes is often used by governments to lure foreign direct investments or increase domestic investment in a certain sector. Corporate taxation can be divided into two categories – taxes on profits and taxes on operations. Taxes on profits number is important for companies that already have a sustainable business model, while taxes on operations is far more significant for companies that are looking to set up new plants or operations.

Tariffs – Chekout how much tariffs the firm needs to pay in the “ GlaxoSmithKline in China (B) ” case study. The level of tariffs will determine the viability of the business model that the firm is contemplating. If the tariffs are high then it will be extremely difficult to compete with the local competitors. But if the tariffs are between 5-10% then Gsk's Gsk can compete against other competitors.

Research and Development Subsidies and Policies – Governments often provide tax breaks and other incentives for companies to innovate in various sectors of priority. Managers at GlaxoSmithKline in China (B) case study have to assess whether their business can benefit from such government assistance and subsidies.

Consumer protection – Different countries have different consumer protection laws. Managers need to clarify not only the consumer protection laws in advance but also legal implications if the firm fails to meet any of them.

Political System and Its Implications – Different political systems have different approach to free market and entrepreneurship. Managers need to assess these factors even before entering the market.

Freedom of Press is critical for fair trade and transparency. Countries where freedom of press is not prevalent there are high chances of both political and commercial corruption.

Corruption level – Gsk's Gsk needs to assess the level of corruptions both at the official level and at the market level, even before entering a new market. To tackle the menace of corruption – a firm should have a clear SOP that provides managers at each level what to do when they encounter instances of either systematic corruption or bureaucrats looking to take bribes from the firm.

Independence of judiciary – It is critical for fair business practices. If a country doesn’t have independent judiciary then there is no point entry into such a country for business.

Government attitude towards trade unions – Different political systems and government have different attitude towards trade unions and collective bargaining. The firm needs to assess – its comfort dealing with the unions and regulations regarding unions in a given market or industry. If both are on the same page then it makes sense to enter, otherwise it doesn’t.

Economic Factors that Impact GlaxoSmithKline in China (B)

Social factors that impact glaxosmithkline in china (b), technological factors that impact glaxosmithkline in china (b), environmental factors that impact glaxosmithkline in china (b), legal factors that impact glaxosmithkline in china (b), step 3 – industry specific analysis, what is porter five forces analysis, step 4 – swot analysis / internal environment analysis, step 5 – porter value chain / vrio / vrin analysis, step 6 – evaluating alternatives & recommendations, step 7 – basis for recommendations, references :: glaxosmithkline in china (b) case study solution.

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We investigate why top-down directives aimed at eradicating corruption are ineffective at altering on-the-ground practices for organizations that have adopted industry-wide “gold standards” to prevent bribery and corruption. Using interview and focus group data collected from leading multinational pharmaceutical firms, we unearth antecedents contributing to organizations’ systemic failure to embed their anticorruption policies in business practice. We identify two tensions that contribute to this disconnect: a culture clash between global and local norms, especially in emerging markets and a similar disconnect between the compliance and commercial functions. To overcome these tensions, we suggest that organizations are likely to find it easier to implement a no gifts policy if they cease to rely on local agents embedded in local norms and that there needs to be strong evidence of board- level commitment to antibribery programs, innovative ways of incentivizing compliant behavior, and a fundamental rethinking of organizations’ business model and remuneration practices.

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GlaxoSmithKline to Plead Guilty and Pay $3 Billion to Resolve Fraud Allegations and Failure to Report Safety Data

Global health care giant GlaxoSmithKline LLC (GSK) agreed to plead guilty and to pay $3 billion to resolve its criminal and civil liability arising from the company’s unlawful promotion of certain prescription drugs, its failure to report certain safety data, and its civil liability for alleged false price reporting practices, the Justice Department announced today. The resolution is the largest health care fraud settlement in U.S. history and the largest payment ever by a drug company.

GSK agreed to plead guilty to a three-count criminal information, including two counts of introducing misbranded drugs, Paxil and Wellbutrin, into interstate commerce and one count of failing to report safety data about the drug Avandia to the Food and Drug Administration (FDA). Under the terms of the plea agreement, GSK will pay a total of $1 billion, including a criminal fine of $956,814,400 and forfeiture in the amount of $43,185,600. The criminal plea agreement also includes certain non-monetary compliance commitments and certifications by GSK’s U.S. president and board of directors. GSK’s guilty plea and sentence is not final until accepted by the U.S. District Court.

GSK will also pay $2 billion to resolve its civil liabilities with the federal government under the False Claims Act, as well as the states. The civil settlement resolves claims relating to Paxil, Wellbutrin and Avandia, as well as additional drugs, and also resolves pricing fraud allegations.

“Today’s multi-billion dollar settlement is unprecedented in both size and scope. It underscores the Administration’s firm commitment to protecting the American people and holding accountable those who commit health care fraud,” said James M. Cole, Deputy Attorney General. “At every level, we are determined to stop practices that jeopardize patients’ health, harm taxpayers, and violate the public trust – and this historic action is a clear warning to any company that chooses to break the law.”

“Today’s historic settlement is a major milestone in our efforts to stamp out health care fraud,” said Bill Corr, Deputy Secretary of the Department of Health and Human Services (HHS). “For a long time, our health care system had been a target for cheaters who thought they could make an easy profit at the expense of public safety, taxpayers, and the millions of Americans who depend on programs like Medicare and Medicaid. But thanks to strong enforcement actions like those we have announced today, that equation is rapidly changing.”

This resolution marks the culmination of an extensive investigation by special agents from HHS-OIG, FDA and FBI, along with law enforcement partners across the federal government. Moving forward, GSK will be subject to stringent requirements under its corporate integrity agreement with HHS-OIG; this agreement is designed to increase accountability and transparency and prevent future fraud and abuse. Effective law enforcement partnerships and fraud prevention are hallmarks of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which fosters government collaboration to fight fraud.

Criminal Plea Agreement

Under the provisions of the Food, Drug and Cosmetic Act, a company in its application to the FDA must specify each intended use of a drug. After the FDA approves the product as safe and effective for a specified use, a company’s promotional activities must be limited to the intended uses that FDA approved. In fact, promotion by the manufacturer for other uses – known as “off-label uses” – renders the product “misbranded.”

Paxil: In the criminal information, the government alleges that, from April 1998 to August 2003, GSK unlawfully promoted Paxil for treating depression in patients under age 18, even though the FDA has never approved it for pediatric use. The United States alleges that, among other things, GSK participated in preparing, publishing and distributing a misleading medical journal article that misreported that a clinical trial of Paxil demonstrated efficacy in the treatment of depression in patients under age 18, when the study failed to demonstrate efficacy. At the same time, the United States alleges, GSK did not make available data from two other studies in which Paxil also failed to demonstrate efficacy in treating depression in patients under 18. The United States further alleges that GSK sponsored dinner programs, lunch programs, spa programs and similar activities to promote the use of Paxil in children and adolescents. GSK paid a speaker to talk to an audience of doctors and paid for the meal or spa treatment for the doctors who attended. Since 2004, Paxil, like other antidepressants, included on its label a “black box warning” stating that antidepressants may increase the risk of suicidal thinking and behavior in short-term studies in patients under age 18. GSK agreed to plead guilty to misbranding Paxil in that its labeling was false and misleading regarding the use of Paxil for patients under 18.

Wellbutrin: The United States also alleges that, from January 1999 to December 2003, GSK promoted Wellbutrin, approved at that time only for Major Depressive Disorder, for weight loss, the treatment of sexual dysfunction, substance addictions and Attention Deficit Hyperactivity Disorder, among other off-label uses. The United States contends that GSK paid millions of dollars to doctors to speak at and attend meetings, sometimes at lavish resorts, at which the off-label uses of Wellbutrin were routinely promoted and also used sales representatives, sham advisory boards, and supposedly independent Continuing Medical Education (CME) programs to promote Wllbutrin for these unapproved uses. GSK has agreed to plead guilty to misbranding Wellbutrin in that its labeling did not bear adequate directions for these off-label uses. For the Paxil and Wellbutrin misbranding offenses, GSK has agreed to pay a criminal fine and forfeiture of $757,387,200.

Avandia: The United States alleges that, between 2001 and 2007, GSK failed to include certain safety data about Avandia, a diabetes drug, in reports to the FDA that are meant to allow the FDA to determine if a drug continues to be safe for its approved indications and to spot drug safety trends. The missing information included data regarding certain post-marketing studies, as well as data regarding two studies undertaken in response to European regulators’ concerns about the cardiovascular safety of Avandia. Since 2007, the FDA has added two black box warnings to the Avandia label to alert physicians about the potential increased risk of (1) congestive heart failure, and (2) myocardial infarction (heart attack). GSK has agreed to plead guilty to failing to report data to the FDA and has agreed to pay a criminal fine in the amount of $242,612,800 for its unlawful conduct concerning Avandia.

“This case demonstrates our continuing commitment to ensuring that the messages provided by drug manufacturers to physicians and patients are true and accurate and that decisions as to what drugs are prescribed to sick patients are based on best medical judgments, not false and misleading claims or improper financial inducements,” said Carmen Ortiz, U.S. Attorney for the District of Massachusetts.

“Patients rely on their physicians to prescribe the drugs they need,” said John Walsh, U.S. Attorney for Colorado. “The pharmaceutical industries’ drive for profits can distort the information provided to physicians concerning drugs. This case will help to ensure that your physician will make prescribing decisions based on good science and not on misinformation, money or favors provided by the pharmaceutical industry.”

Civil Settlement Agreement

As part of this global resolution, GSK has agreed to resolve its civil liability for the following alleged conduct: (1) promoting the drugs Paxil, Wellbutrin, Advair, Lamictal and Zofran for off-label, non-covered uses and paying kickbacks to physicians to prescribe those drugs as well as the drugs Imitrex, Lotronex, Flovent and Valtrex; (2) making false and misleading statements concerning the safety of Avandia; and (3) reporting false best prices and underpaying rebates owed under the Medicaid Drug Rebate Program.

Off-Label Promotion and Kickbacks: The civil settlement resolves claims set forth in a complaint filed by the United States alleging that, in addition to promoting the drugs Paxil and Wellbutrin for unapproved, non-covered uses, GSK also promoted its asthma drug, Advair, for first-line therapy for mild asthma patients even though it was not approvedor medically appropriate under these circumstances. GSK also promoted Advair for chronic obstructive pulmonary disease with misleading claims as to the relevant treatment guidelines. The civil settlement also resolves allegations that GSK promoted Lamictal, an anti-epileptic medication, for off-label, non-covered psychiatric uses, neuropathic pain and pain management. It further resolves allegations that GSK promoted certain forms of Zofran, approved only for post-operative nausea, for the treatment of morning sickness in pregnant women. It also includes allegations that GSK paid kickbacks to health care professionals to induce them to promote and prescribe these drugs as well as the drugs Imitrex, Lotronex, Flovent and Valtrex. The United States alleges that this conduct caused false claims to be submitted to federal health care programs.

GSK has agreed to pay $1.043 billion relating to false claims arising from this alleged conduct. The federal share of this settlement is $832 million and the state share is $210 million.

This off-label civil settlement resolves four lawsuits pending in federal court in the District of Massachusetts under the qui tam , or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery.

Avandia: In its civil settlement agreement, the United States alleges that GSK promoted Avandia to physicians and other health care providers with false and misleading representations about Avandia’s safety profile, causing false claims to be submitted to federal health care programs. Specifically, the United States alleges that GSK stated that Avandia had a positive cholesterol profile despite having no well-controlled studies to support that message. The United States also alleges that the company sponsored programs suggesting cardiovascular benefits from Avandia therapy despite warnings on the FDA-approved label regarding cardiovascular risks. GSK has agreed to pay $657 million relating to false claims arising from misrepresentations about Avandia. The federal share of this settlement is $508 million and the state share is $149 million.

Price Reporting: GSK is also resolving allegations that, between 1994 and 2003, GSK and its corporate predecessors reported false drug prices, which resulted in GSK’s underpaying rebates owed under theMedicaid Drug Rebate Program. By law, GSK was required to report the lowest, or “best” price that it charged its customers and to pay quarterly rebates to the states based on those reported prices. When drugs are sold to purchasers in contingent arrangements known as “bundles,” the discounts offered for the bundled drugs must be reallocated across all products in the bundle proportionate to the dollar value of the units sold. The United States alleges that GSK had bundled sales arrangements that included steep discounts known as “nominal” pricing and yet failed to take such contingent arrangements into account when calculating and reporting its best prices to the Department of Health and Human Services. Had it done so, the effective prices on certain drugs would have been different, and, in some instances, triggered a new, lower best price than what GSK reported. As a result, GSK underpaid rebates due to Medicaid and overcharged certain Public Health Service entities for its drugs, the United States contends. GSK has agreed to pay $300 million to resolve these allegations, including $160,972,069 to the federal government, $118,792,931 to the states, and $20,235,000 to certain Public Health Service entities who paid inflated prices for the drugs at issue.

Except to the extent that GSK has agreed to plead guilty to the three-count criminal information, the claims settled by these agreements are allegations only, and there has been no determination of liability.

“This landmark settlement demonstrates the Department’s commitment to protecting the American public against illegal conduct and fraud by pharmaceutical companies,” said Stuart F. Delery, Acting Assistant Attorney General for the Justice Department’s Civil Division. “Doctors need truthful, fair, balanced information when deciding whether the benefits of a drug outweigh its safety risks. By the same token, the FDA needs all necessary safety-related information to identify safety trends and to determine whether a drug is safe and effective. Unlawful promotion of drugs for unapproved uses and failing to report adverse drug experiences to the FDA can tip the balance of those important decisions, and the Justice Department will not tolerate attempts by those who seek to corrupt our health care system in this way.”

Non-monetary Provisions and Corporate Integrity Agreement

In addition to the criminal and civil resolutions, GSK has executed a five-year Corporate Integrity Agreement (CIA) with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). The plea agreement and CIA include novel provisions that require that GSK implement and/or maintain major changes to the way it does business, including changing the way its sales force is compensated to remove compensation based on sales goals for territories, one of the driving forces behind much of the conduct at issue in this matter. Under the CIA, GSK is required to change its executive compensation program to permit the company to recoup annual bonuses and long-term incentives from covered executives if they, or their subordinates, engage in significant misconduct. GSK may recoup monies from executives who are current employees and those who have left the company. Among other things, the CIA also requires GSK to implement and maintain transparency in its research practices and publication policies and to follow specified policies in its contracts with various health care payors.

“Our five-year integrity agreement with GlaxoSmithKline requires individual accountability of its board and executives,” said Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. “For example, company executives may have to forfeit annual bonuses if they or their subordinates engage in significant misconduct, and sales agents are now being paid based on quality of service rather than sales targets.”

“The FDA Office of Criminal Investigations will aggressively pursue pharmaceutical companies that choose to put profits before the public’s health,” said Deborah M. Autor, Esq., Deputy Commissioner for Global Regulatory Operations and Policy, U.S. Food and Drug Administration. “We will continue to work with the Justice Department and our law enforcement counterparts to target companies that disregard the protections of the drug approval process by promoting drugs for uses when they have not been proven to be safe and effective for those uses, and that fail to report required drug safety information to the FDA.”

“The record settlement obtained by the multi-agency investigative team shows not only the importance of working with our partners, but also the importance of the public providing their knowledge of suspect schemes to the government,” said Kevin Perkins, Acting Executive Assistant Director of the FBI’s Criminal, Cyber, Response and Services Branch. “Together, we will continue to bring to justice those engaged in illegal schemes that threaten the safety of prescription drugs and other critical elements of our nation’s healthcare system.”

“ Federal employees deserve health care providers and suppliers, including drug manufacturers, that meet the highest standards of ethical and professional behavior,” said Patrick E. McFarland, Inspector General of the U.S. Office of Personnel Management. “Today’s settlement reminds the pharmaceutical industry that they must observe those standards and reflects the commitment of Federal law enforcement organizations to pursue improper and illegal conduct that places health care consumers at risk.”

“Today’s announcement illustrates the efforts of VA OIG and its law enforcement partners in ensuring the integrity of the medical care provided our nation’s veterans by the Department of Veterans Affairs,” said George J. Opfer, Inspector General of the Department of Veterans Affairs. “The monetary recoveries realized by VA in this settlement will directly benefit VA healthcare programs that provide for veterans’ continued care.”

“This settlement sends a clear message that taking advantage of federal health care programs has substantial consequences for those who try,” said Rafael A. Medina, Special Agent in Charge of the Northeast Area Office of Inspector General for the U.S. Postal Service. “The U.S. Postal Service pays more than one billion dollars a year in workers' compensation benefits and our office is committed to pursuing those individuals or entities whose fraudulent acts continue to unfairly add to that cost.”

A Multilateral Effort

The criminal case is being prosecuted by the U.S. Attorney’s Office for the District of Massachusetts and the Civil Division’s Consumer Protection Branch. The civil settlement was reached by the U.S. Attorney’s Office for the District of Massachusetts, the U.S. Attorney’s Office for the District of Colorado and the Civil Division’s Commercial Litigation Branch. Assistance was provided by the HHS Office of Counsel to the Inspector General, Office of the General Counsel-CMS Division and FDA’s Office of Chief Counsel as well as the National Association of Medicaid Fraud Control Units.

This matter was investigated by agents from the HHS-OIG; the FDA’s Office of Criminal Investigations; the Defense Criminal Investigative Service of the Department of Defense; the Office of the Inspector General for the Office of Personnel Management; the Department of Veterans Affairs; the Department of Labor; TRICARE Program Integrity; the Office of Inspector General for the U.S. Postal Service and the FBI.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Kathleen Sebelius, Secretary of HHS. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. Over the last three years, the department has recovered a total of more than $10.2 billion in settlements, judgments, fines, restitution, and forfeiture in health care fraud matters pursued under the False Claims Act and the Food, Drug and Cosmetic Act.

Court documents related to today’s settlement can be viewed online at www.justice.gov/opa/gsk-docs.html .

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Remarks by the Deputy Attorney General James M. Cole at the GSK Press Conference Remarks by Acting Assistant Attorney General for the Civil Division Stuart F. Delery at the GSK Press Conference

Glaxosmithkline In China C Case Study Analysis

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Glaxosmithkline In China C is presently among the most significant food cycle worldwide. It was established by Ivey in 1866, a German Pharmacist who first launched "FarineLactee"; a mix of flour and milk to feed infants and decrease death rate. At the same time, the Page brothers from Switzerland also found The Anglo-Swiss Condensed Milk Business. The two ended up being competitors at first however later merged in 1905, resulting in the birth of Glaxosmithkline In China C. Business is now a multinational business. Unlike other multinational companies, it has senior executives from various nations and attempts to make choices considering the whole world. Glaxosmithkline In China C presently has more than 500 factories worldwide and a network spread throughout 86 countries.

The purpose of Business Corporation is to enhance the quality of life of individuals by playing its part and providing healthy food. While making sure that the company is prospering in the long run, that's how it plays its part for a better and healthy future

Glaxosmithkline In China C's vision is to provide its consumers with food that is healthy, high in quality and safe to consume. It wishes to be ingenious and simultaneously understand the needs and requirements of its clients. Its vision is to grow quick and offer products that would please the requirements of each age. Glaxosmithkline In China C envisions to establish a trained workforce which would help the company to grow .

Glaxosmithkline In China C's mission is that as currently, it is the leading business in the food market, it thinks in 'Excellent Food, Great Life". Its mission is to supply its consumers with a variety of choices that are healthy and best in taste also. It is concentrated on offering the best food to its consumers throughout the day and night.

Glaxosmithkline In China C has a wide variety of items that it uses to its consumers. In 2011, Business was listed as the most gainful organization.

Goals and Objectives

• Remembering the vision and mission of the corporation, the company has put down its goals and objectives. These goals and goals are noted below. • One goal of the company is to reach no land fill status. It is working toward zero waste, where no waste of the factory is landfilled. It motivates its workers to take the most out of the by-products. (Business, aboutus, 2017). • Another goal of Glaxosmithkline In China C is to lose minimum food during production. Usually, the food produced is wasted even before it reaches the consumers. • Another thing that Business is dealing with is to improve its packaging in such a way that it would help it to reduce those complications and would likewise guarantee the shipment of high quality of its items to its consumers. • Meet international requirements of the environment. • Develop a relationship based on trust with its consumers, business partners, workers, and government.

Critical Issues

Just Recently, Business Company is focusing more towards the technique of NHW and investing more of its profits on the R&D technology. The nation is investing more on acquisitions and mergers to support its NHW technique. The target of the business is not achieved as the sales were anticipated to grow greater at the rate of 10% per year and the operating margins to increase by 20%, provided in Exhibit H. There is a requirement to focus more on the sales then the development technology. Otherwise, it may result in the decreased income rate. (Henderson, 2012).

Situational Analysis.

Analysis of current strategy, vision and goals.

The existing Business technique is based on the concept of Nutritious, Health and Wellness (NHW). This method deals with the idea to bringing modification in the customer choices about food and making the food things much healthier worrying about the health issues. The vision of this method is based on the key approach i.e. 60/40+ which merely means that the products will have a rating of 60% on the basis of taste and 40% is based on its nutritional value. The items will be produced with extra nutritional value in contrast to all other items in market acquiring it a plus on its dietary material. This method was adopted to bring more tasty plus healthy foods and beverages in market than ever. In competition with other business, with an intent of keeping its trust over clients as Business Company has gotten more relied on by clients.

Quantitative Analysis.

R&D Costs as a portion of sales are declining with increasing actual quantity of costs shows that the sales are increasing at a greater rate than its R&D spending, and enable the company to more spend on R&D. Net Earnings Margin is increasing while R&D as a percentage of sales is declining. This sign also reveals a thumbs-up to the R&D spending, mergers and acquisitions. Debt ratio of the company is increasing due to its spending on mergers, acquisitions and R&D advancement instead of payment of financial obligations. This increasing financial obligation ratio posture a threat of default of Business to its financiers and could lead a decreasing share prices. For that reason, in terms of increasing debt ratio, the company ought to not invest much on R&D and should pay its present financial obligations to reduce the threat for financiers. The increasing risk of financiers with increasing debt ratio and decreasing share prices can be observed by substantial decrease of EPS of Glaxosmithkline In China C stocks. The sales growth of business is also low as compare to its mergers and acquisitions due to slow perception structure of consumers. This sluggish development likewise impede business to additional invest in its mergers and acquisitions.( Business, Business Financial Reports, 2006-2010). Keep in mind: All the above analysis is done on the basis of calculations and Charts given in the Exhibitions D and E.

TWOS Analysis

TWOS analysis can be utilized to obtain various strategies based upon the SWOT Analysis provided above. A short summary of TWOS Analysis is given in Exhibition H.

Strategies to exploit Opportunities using Strengths

Business should present more ingenious items by large amount of R&D Costs and mergers and acquisitions. It could increase the marketplace share of Business and increase the revenue margins for the business. It could likewise supply Business a long term competitive benefit over its rivals. The worldwide expansion of Business need to be focused on market capturing of developing countries by expansion, attracting more consumers through consumer's loyalty. As establishing nations are more populous than industrialized countries, it might increase the client circle of Business.

Strategies to Overcome Weaknesses to Exploit Opportunities

Strategies to use strengths to overcome threats

Business ought to move to not only developing but likewise to industrialized nations. It must widen its circle to numerous countries like Unilever which operates in about 170 plus countries.

Strategies to overcome weaknesses to avoid threats

It should acquire and merge with those countries having a goodwill of being a healthy company in the market. It would likewise allow the company to use its potential resources effectively on its other operations rather than acquisitions of those companies slowing the NHW method development.

Segmentation Analysis

Demographic segmentation.

The market segmentation of Business is based on four aspects; age, gender, earnings and occupation. Business produces numerous products related to babies i.e. Cerelac, Nido, etc. and associated to grownups i.e. confectionary products. Glaxosmithkline In China C products are quite inexpensive by nearly all levels, but its significant targeted consumers, in regards to earnings level are middle and upper middle level customers.

Geographical Segmentation

Geographical division of Business is made up of its existence in almost 86 countries. Its geographical segmentation is based upon two main aspects i.e. typical income level of the consumer in addition to the environment of the area. Singapore Business Company's segmentation is done on the basis of the weather condition of the area i.e. hot, warm or cold.

Psychographic Segmentation

Psychographic division of Business is based upon the personality and lifestyle of the consumer. For example, Business 3 in 1 Coffee target those clients whose life style is quite busy and don't have much time.

Behavioral Segmentation

Glaxosmithkline In China C behavioral division is based upon the attitude understanding and awareness of the client. For example its highly healthy products target those consumers who have a health conscious mindset towards their usages.

Glaxosmithkline In China C Alternatives

Glaxosmithkline In China C Conclusion

Glaxosmithkline In China C Exhibits

Open access
Published: 12 April 2024

Physiology education in China: the current situation and changes over the past 3 decades

Xuhong Wei 1 na1 ,
Ting Xu 1 na1 ,
Ruixian Guo 1 ,
Zhi Tan 1 &
Wenjun Xin 1

BMC Medical Education volume 24 , Article number: 408 ( 2024 ) Cite this article

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As an experimental biological science, physiology has been taught as an integral component of medical curricula for a long time in China. The teaching effectiveness of physiology courses will directly affect students' learning of other medical disciplines. The purpose of this study is to investigate the current situation and changes in physiology teaching over 30 years in Chinese medical schools.

National survey was conducted online on the platform SoJump via WeChat and the web. The head of the physiology department in medical school was asked to indicate the information of physiology education from three periods: 1991–2000, 2001–2010, and 2011–2020. The responses of 80 leaders of the Department of Physiology from mainland Chinese medical schools were included in the study for analysis.

The survey showed that the class hours, both of theory and practice, had been decreased. During the past 20 years, the total number of physiology teachers, the number of physiology teachers who had been educated in medical schools, and the number of technicians had been reduced, whereas teachers with doctor’s degrees had been increased. In addition to traditional didactic teaching, new teaching approaches, including problem-based learning/case-based learning/team-based learning, integrated curriculum and formative evaluation systems, had been employed, mostly for more than 5 years, in some medical schools.

The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years by showing that physiology education in China has developed quickly,even it faces many challenges.

Peer Review reports

Physiology is an important foundational discipline in medical schools [ 1 ]. It studies how different cells, tissues and organs work together to maintain the normal function of the human body. The task of medical students is to learn how to diagnose and treat diseases. Therefore, it is necessary to first understand the functions of the normal human body by studying physiology, laying the foundation for subsequent courses, such as pharmacology, pathophysiology and clinical disciplines.

In 1998, the “Education Promotion Plan for the 21st Century” was published by the Ministry of Education of China. Since then, a massive increase in medical student enrollment has occurred [ 2 ]. Additionally, in 1998, stand-alone medical schools from the former Soviet model were merged into comprehensive universities in China to follow the model of medical education in the United States and other countries [ 2 , 3 ]. These changes accordingly raised new challenges to medical education, for example, a rapid increase in the number of students without sufficient teachers and a lack of effective teaching strategies and methods. Thus, a survey on the current situation and changes in physiology education, including course hours and teaching staff, is necessary.

The traditional teaching model in physiology courses relies heavily on teacher-centered didactic lectures, with the students being given approximately 90 min of theoretical knowledge in the classroom in their second year of study. There were also a number of laboratory practices that ran concurrently with or subsequent to the lectures. Lecture-based learning (LBL) is good at transferring massive knowledge, the foundational cognitive skill from information professionals to students, but is often limited in facilitating the development of Bloom’s higher-order cognitive skills in students [ 4 ] due to passive acceptance of knowledge. Instructional strategies, such as problem-based learning (PBL), case-based learning (CBL) and team-based learning (TBL), which can promote active learning, have been widely adopted in medical education [ 5 , 6 , 7 , 8 , 9 , 10 ]. Their common merits involve developing cooperation among students, arousing consciousness of lifelong learning and improving problem-solving skills. In 2016, the "Chinese Undergraduate Medical Education Standards—Clinical Medicine Major" was released by the Ministry of Education, which aimed to develop student-centered and self-directed learning as the main content of educational strategies. This pointed out the direction for improving the level of medical education in China. Thereafter, an increasing number of student-centered learning methods, including PBL, CBL and TBL, are gradually being integrated into Chinese medical education. For example, problem-based self-designed experiments in physiology laboratory teaching are currently being adopted in Zhejiang University School of Medicine [ 11 ]. However, a national survey of the current PBL/CBL/TBL application status in physiology is still lacking.

In the 1950s, Case Western Reserve University first implemented an organ-system-based curriculum. In 1993, the curriculum reform of the Edinburgh World Medical Education Summit and the National Outstanding Doctor Training Plan opened the prelude to curriculum integration teaching in domestic medical colleges. In 1994, Reagan and Menninger reported on 10 years of experience by integrating physiology with other basic biomedical disciplines, such as anatomy, biochemistry, and pharmacology, in a PBL format [ 12 ]. In 2002, Shantou University Medical Schools first adopted an integrated curriculum in China [ 13 ]. In 2013, an integrated medical curriculum between basic medical courses and clinical curriculum was required in “several opinions of the ministry of health on implementing comprehensive reform of clinical medical education” [ 14 ]. Since then, the curriculum integration teaching model based on the concept of medical integrity and centered on the Organ system has become the new teaching reform. In 2020, the State Council General Office also stated “accelerating the innovative development of medical education and promote classroom reform in medical education by applying modern information technology in medical education” in China [ 15 ]. Under the new situation, reform in medical education has been accelerated, and the integration of modern information technologies in physiology teaching has been promoted.

In China, 11 broad categories, such as basic medicine, clinical medicine, stomatology, public health and preventive medicine, traditional Chinese medicine, were included in medical education. Clinical medicine is the main body of the medical education system in China, with 192 medical schools providing clinical medicine education [ 16 , 17 ]. As a particularly important basic medicine, it is taught as a discipline-based curriculum that emphasizes one-sidedness but lacks the overall concept of medicine in most medical schools,. Integrated teaching can integrate physiology with other disciplines, such as anatomy, pharmacology or clinical curricula, in a unified manner, thereby strengthening students' cognition of disease from different dimensions and levels, which is beneficial for broadening students' vision and reducing repetitive and unnecessary teaching content. In the 1950s, an organ-system-based integrated curriculum was first implemented at Case Western Reserve University. The integrated curriculum of medical education in China began in the 1990s [ 18 , 19 ]. In 2014, the "Deepening the cultivation of clinical medical talents through clinical practice and medical education collaboration" was issued by the Chinese Ministry of Education (MOE) [ 20 ]. This might greatly accelerate the reform of integrated medical courses.

A recent published study by Feng et al. has evaluated changes in Chinese medical schools for Physiology teaching over the last 20 years [ 21 ]. For the better development of physiology curricula, in the present study, we conducted a survey on physiology teaching in China to understand the current state and changes in the past 30 years, including course hours in theory and practice, faculty compositions, practice type and conducting time, and teaching approaches. Different to Feng’s study, in the present study we payed more attention to the changes of experiments type and the new teaching approaches. In addition to achieving the similar results as Feng’s study [ 21 ], we found that the total number of teachers in the physiology department had gradually decreased in the past 30 years, which was different from Feng’s study showing that the total number of physiology teachers was reported unchanged in most schools. We also found that the explorative and virtual experiments have developed quickly, which has not been reported previously. Moreover, our results also showed different integration content.

Study design

The main purpose of the study was to understand the current situation and changes in physiology education and teaching in the Chinese mainland, focusing on course hours, faculty compositions, practice type and conducting time, and teaching approaches. The changes in physiology teaching, particular the decline rate in course hours in the past 30 years, was the main outcome measures. Therefore, we had estimated the the decline rate by consulting literature in advance. A line of previous study has shown that a total of 83.33% of the surveyed schools have reduced their Histology and Embryology Education, which is also an important course in basic medicine in China [ 22 ]. We estimated the contact hour of physiology was reduced similarly. According to the formula Z 2 1 -ɑ/2 *pq/d 2 , in which Z 1-ɑ/2 = 1.96, p = 83.33%, q = 1–83.33% = 16.77%, d = 0.1* p = 8.33%, the estimated sample size was 79, which meant that we need to include decline rate in physiology course hours from at least 79 medical schools to achieve effectiveness. Accordingly, we conducted a nationwide survey of the top 100 medical schools (according to Evaluation Metrics (STEM) and 5- year total STEM [accumulative STEM (ASTEM)] http://top100.imicams.ac.cn/ASTEM/college ), including different levels of ranked universities in China, including Project 985, Project 211 schools, and ordinary universities. All of them have had a five-year clinical medicine programs for at least ten years, as the present study investigated only five-year clinical medicine programs, which are the most popular medical program in China. Therefore, we thought the top 100 schools could represent the whole China and could meet the research needs. The present study was conducted on line from November 2020 to June 2021. Under the approval of the college research and ethics committee, a cross-sectional study was conducted among the directors of the physiology departments of the top 100 medical schools, excluding those Hong Kong, Taiwan and Macau, and these medical institutions that are distributed in various provinces. Traditional Chinese medical schools, specialist technology colleges, and medical schools without five-years medical programs were also excluded.

Eligibility criteria for participants

Inclusion criteria for choosing participants for this study involved: (1) participants should be directors of the physiology departments, that usually had extensive practical experience in teaching and had experienced or witnessed changes in theoretical and laboratory teaching reform in physiology over the past 30 years. (2) participants should be from the top 100 medical schools, distributed throughout almost every provincial-level administrative division in mainland China. (3) The participants had completed their PhD or MD degrees and had taught physiology in medical schools for at least one year. (4) Both male and female could be included.

Data collection

Quantitative data were generated from a self-administered survey questionnaire. The questions was first generated from the perspective of front line physiology teachers, who had extensive practical experience in teaching and had experienced or witnessed changes in theoretical and laboratory teaching reform in physiology over the past 30 years. Then the questionnaire was designed based on the published literature, discussed by the authors and tested by teachers from the corresponding author’s school and was subsequently revised based on the feedback to ensure clarity of the questions. Therefore, the description of each question was easy to understand and was structured elaborately, and more importantly, it is suitable to evaluate the teachers’ perspectives regarding the current situation and changes over the past 3 decades in physiology education in China. The questionnaire contained 26 main questions, 4 of which were jump questions. The questionnaire was designed based on the published literature (22). The survey was developed to collect factual information covering three main areas of physiology education: (1) the changes in course hours, including theory and practice, during the past 30 years. There were 11 questions. All the questions were filling in the blank except question 4. For example, question 2 was: What was the duration of physiological theory courses in clinical medicine at your university, from 2001 to 2010; (2) the changes in physiology teaching strategies and assessment. There were 15 questions. For example, question 12 was: The physiological experiment course in the clinical medicine major of your university is set as the following: (If the option includes exploratory experiments, please answer 12a. If the option does not include exploratory experiments, please choose no in 12a). There were 8 choices for question 12, including A. basic; B. comprehensive; C, explorative; D, basic and comprehensive; E, basic and explorative, F, comprehensive and explorative; G, basic, comprehensive and explorative practices; H, no. Question 12a was: What was topic selection method for exploratory experiments at your university? The choices for question 12 was: A, designed by students and tutored by teachers; B, designed by the students; C, designated by the teachers; D, No. (3) Changes in the teaching staff in physiology education. There were 10 questions. For example, question 19 was: What is the proportion of physiology teachers with doctoral degrees that are teaching clinical medicine currently at your university? The choices for question 19 was: A, ≤ 50%; B, 51%-70%; C, 71%-90%; D ≥ 90%. Hence there were a total of 37 questions in the whole questionnaire, including the last question requiring the participants to show their names and schools. The questionnaire is not a structured scale with similar scale anchors or values (The anchor ran from 1 = ‘Not at all’ to 5 = ‘To a very large extent’). There is weak correlation between questions and each question has different rating level. The directors of the physiology departments of these schools were in a messaging group in the WeChat application (Tencent Holdings Ltd., Shenzhen, China). The participants was first informed all about the study’s purpose, their right to withdraw at any time, and that their data would not be leaked. A two-dimensional code (SoJump, 2019, attached in Supplementary Material 1 ) invitation to participate in the online survey on the platform SoJump (Changsha Ranxing Information Technology Co Ltd., Changsha, China) was then sent to the WeChat group, a popular social media mobile application. Participation was voluntary and unrewarding. Respondents completed and submitted the questionnaire via mobile phone or computer, which has unique IP address, so that the authors could know whether one participants had submitted the answers twice with the same device. To increase their engagement and the authenticity of their answers, the participants were required to read the instructions before doing the survey. The contact information of the participants was also sought through personal contacts and websites. Most completed surveys were followed up with phone calls or email to confirm the accuracy of the information, to clarify obscure answers and to help the respondents complete omitted items if they were willing to do so. The results will not be adopted in statistics if the filling time was too short and the incomplete information could not be supplemented. To prevent the use of repeated responses from the same medical school, the respondents were required to show their institutions. The directors were also required to show their names to ensure that they submitted a single answer from each school. In addition, the answers could also give hints whether the participants had taken the survey seriously as some items from different questions confirm each other. For example, the number of participants that choose choice H in question 12, choice E in question 12a and choice G in question 13a are the same, which means the same content that the authors wanted to obtain was answered consistently by the participants, even the content was presented in different ways.

Finally, a total of 82 responses (from 51 female and 31 male participants) were finally identified as valid, however, 4 different participates from 2 schools were identified to have submitted the questionnaire simultaneously, and therefore only 80 medical schools have attended the survey. The surveyed schools were more than that in Xin Cheng’s study, which was 66 (22). Hence, the survey response rate was considered 80%. How the 82 directors from the 80 medical schools represent the overall total medical teachers are shown in Table 1 .

Statistical analysis

Statistical analysis questionnaires with missing items were considered ineffective and excluded from subsequent analysis. The data collected were tabulated in Microsoft Excel 2016. All statistical analyses were performed using GraphPad (Prism 8.0, San Diego, CA). One-way analysis of variance (ANOVA) (with the post hoc Tukey test) was performed to assess the physiological contact hours. For all tests, P < 0.05 was considered significant. The results are expressed as the means ± SD. Effect size was shown by Cohen’s d value, which is determined by calculating the mean difference between two groups and then dividing the result by the pooled SD, that is, Cohen’s d = (Mean2-Mean1)/SD pooled, where SDpooled = √(SD1 2 + SD2 2 )∕2. To determine the internal consistency of the responses, Cronbach’s alpha test was used to analyze the data obtained from the questionnaires.

The geographical distribution of the surveyed medical schools

Finally, the 80 medical schools that had attended the survey were distributed in 29 provinces/municipalities. The geographical distribution of the surveyed medical schools is summarized in detail in Table 2 .

Changes in course hours in the physiology curriculum

This study focused on the current status and the changes in physiology education and teaching in China, however, some participants are not familar with early physiology teaching, making it challenging to get exact information. We have informed the participants that they could leave blank if they don't know the answer. At last we found that among the 80 medical schools, 76 participants supplied the exact number of their current physiology contact hours from 1991 to 2020. From Fig. 1 , we can see that compared to 1991–2000, the schools with class hours > 110 had been gradually reduced in 2001–2010, and had disappeared in 2011–2020. In contrast, the schools with class hours in the range of 51–70 had been continuously increased in the past 3 decades (Fig. 1 A-C). As shown in Fig. 1 D, the average contact hours of physiology were gradually decreased in the past 3 decade. in the 76 medical schools (mean ± SEM, 73.2 ± 1.4 for 2011–2020, 80 ± 1.4 for 2001–2010, 85.9 ± 2 for 1991–2000, F(2,225) = 15.51, P < 0.0001).

Survey of various aspects of changes of physiology curriculum in Chinese medical schools in the past 3 decades. A - C The bar charts show the numbers of schools with each range of the total number of contact hours of physiology in the 3 period as indicated in the surveyed Chinese medical schools. D Comparison of the average physiology (theory) contact hours in each academic year in the 3 periods. * P < 0.05; ** P < 0.01, **** P < 0.0001 compared to the related group

Changes in physiology teachers

The same survey was also conduced to understand the changes in physiology teachers, who are the primary resource for educational development. From the survey, it was found that most directors of physiology departments who responded to the survey were experienced in physiology teaching. As shown in Fig. 2 A, among the 82 respondents, most of them have had a range of 26 to 35 years, even 10 had more than 36 years of teaching experience; only 1 had ≤ 5 years of experience. The present study also showed that in the majority of the medical schools, > 70% of the teachers had received their doctor’s degree (Fig. 2 B), demonstrating that the physiology teachers had good educational backgrounds. Furthermore, in 10, 29, 24 and 17 of the surveyed 80 medical schools, ≤ 50%, 51%-70%, 71%-90%, and ≥ 90% of the teachers had been educated in medical schools, respectively (Fig. 2 C). A massive increase in student enrollment in medical schools has occurred since 1998 in China. To understand whether there was a sufficient number of physiology teaching staff to ensure teaching quality in China, the appropriate number of teachers who had worked at the same time in the physiology department in the past 30 years was quantified. The results show the numbers of surveyed medical schools with different teacher numbers in the three periods of 1991–2000, 2001–2010, and 2011–2020. The results showed that the number of schools that had teachers ranging from 1–10 increased continuously, whereas the number of schools that had teachers ranging from 11–20 decreased continuously in the pat 3 decades (Fig. 2 D). Compared to 20 years ago, most of the surveyed schools had decreased numbers of teachers possessing medical doctor’s degrees in the physiology departments (Fig. 2 E).

Survey of various aspects of physiology teachers at the surveyed Chinese medical schools. A The numbers of directors of physiology with each range of physiology teaching experience. B-C , each percentage range of physiology teachers with doctor’s degree ( B ) and with medical educational backgrounds ( C ). D The changes in the percentages of the total number of physiology teachers within the 3 periods. E , F Changes of the numbers of physiology teachers with medical educational backgrounds ( E ) and the number of technician staff ( F ) over the past two decades

Technicians contribute greatly to physiology education by preparing the material and maintaining experimental instruments and related software. The survey showed, however, that the number of technicians, compared to that 20 years ago, decreased in 46.3% of Chinese medical schools and increased in only 30.5% of medical schools (Fig. 2 F), suggesting that there have not been enough technicians in recent years.

Changes in physiology practice

Experimentation is fundamental to scientific methods of physiology. A range of 31 to 60 course hours in physiology practice in clinical medicine major in China was predominant. The course hours in the range of 60–90 greatly decreased during the period of 2000–2009 compared to 1990–1999 (Fig. 3 A). The numbers of schools that having less than 30 students in each laboratory had decreased continuously from 1991 to 2000, whereas the numbers of schools that having 41–60 students in each laboratory were gradually increased since 1991 (Fig. 3 B). In each laboratory in the medical schools in China, usually only one teacher tutors all the students when they are doing the practice. Therefore, an increased number of students in each laboratory will lessen the amount of time that the teacher can communicate with each student. According to the survey results, regarding the types of practice, basic, comprehensive, basic and comprehensive, basic and explorative, comprehensive and explorative, and basic, comprehensive and explorative practices were conducted in 9%, 1.3%, 29.5%, 10.3%, 2.6%, and 47.4% of the surveyed schools, respectively (Fig. 3 C).

Survey of various aspects of physiology laboratory practice in Chinese medical schools. A- B The bar charts show the numbers of schools with each ratio of practice courses hours for physiology ( A ), with each range of the number of students in each laboratory ( B ). C , the setting types of practice in the surveyed Chinese medical schools are shown. D , E The pie charts show the percentage of schools that started explorative practice in the 3 period ( D ) or how the explorative practice topics was selected ( E ) compared to those 20 years ago in the surveyed Chinese medical schools. F The pie chart show the percentage of schools that employed physical experiments, virtual experiments, physical experiments combined with virtual experiments, physical experiments combined with watching videos, physical experiments combined with virtual experiments and watching videos, respectively. G The bar charts show the numbers of schools with each range of virtual experiments conducting time. H The bar charts show the numbers of schools with each virtual experiment sources

Regarding explorative practices, 28 schools had adopted them for less than 5 years, 19 for more than 5 years but less than 10 years, 12 for 11–15 years, and only 2 for more than 15 years. Sixteen schools had not yet adopted explorative practices (Fig. 3 D).

In 63.4% of the surveyed schools, the exploratory practice topic was designed by students and tutored by teachers. In 23.9% and 12.7% of the surveyed schools, it was designed by the students or by the teachers, respectively (Fig. 3 E).

It is difficult to control testing variables in physical experiments. Videos that showing experiments procedures and virtual experiments are becoming considerable options that have greatly altered physiology teaching. A total of 10.3%, 6.4%, 24.4%, 35.9% and 23.1% of the surveyed schools employed physical experiments, virtual experiments, physical experiments combined with virtual experiments, physical experiments combined with watching videos, physical experiments combined with virtual experiments and watching videos, respectively (Fig. 3 F). Virtual experiments had been employed for less than 5 years in 28 and 19 of the surveyed schools, whereas it had been employed for more than 10 years in only 14 schools. In 16 schools, virtual experiments have not yet been employed (Fig. 3 G). Furthermore, the virtual experiment sources were purchased from the company in most of the surveyed schools, secondly developed by the school and the company together. Only 2 schools developed the virtual experiments by themselves (Fig. 3 H).

Changes in physiology teaching approaches

Medical education in the West has undergone several influential reforms, such as the development of PBL at McMaster University in the 1960s [ 23 ] and an integrated curriculum at Newcastle University and Case Western Reserve University in the 1990s [ 18 , 19 ]. The survey was conducted to understand whether these reforms have also influenced physiology education. The results showed that in addition to traditional didactic teaching, teaching methods have also been innovated in some medical schools in China.

At the time survey, PBL, CBL or TBL had been implemented in 74.4% schools, integrated curriculum models had been tried in 68.2% medical school, and formative evaluation systems had been established in 75.1% schools (Fig. 4 A). In the schools that had tried PBL, CBL or TBL, 61.3% of them had experience of more than 5 years). 57.1% of the schools that had implemented integrated curriculum models for more than 5 years. In addition, 46.9% of the schools had tried formative evaluation systems for more than 5 years (Fig. 4 B).

Survey of various aspects of physiology teaching strategies and assessments in Chinese medical schools. A The bar charts show the percentages of the medical schools that have or have not implemented PBL/CBL/TBL, integrated curricula, and formative assessments. B The percentages of the medical schools with each range of employing time of PBL, integrated curricula, and formative assessments. C The percentages of the medical schools that have employed PBL/CBL/TBL in all chapters, partial chapters or system-oriented local content of physiology. D The pie charts show the percentages regarding with which course physiology have been integrated with. E , How the contact hour of physiology changed after integration

Moreover, the survey also demonstrated that over half of the schools (55.7%) implemented the PBL/CBL/TBL curriculum in partial chapters of physiology textbooks. A total of 36.1% had implemented system-oriented local content, and only 8.1% had implemented it in all chapters of physiology textbooks (Fig. 4 C). A total of 63.1% of the schools that reported implementing integrated curricula also reported integration with clinical sciences, 21.1% with basic medical science, 10.5% reported integration theory with practice, and 5.3% reported integration with other curricula. At the time of the survey, curricular integration between theory and practice was reported in 10.5% of the surveyed schools. Integration with clinical sciences and other basic medical sciences was reported in 63.2% and 21.1% of the surveyed medical schools, respectively (Fig. 4 D). Furthermore, at least half of the schools that had conducted integrated curricula reported reduced contact hours in physiology. A total of 32.8% and 10.3% reported intact and growing contact hours after integration, respectively (Fig. 4 E).

Physiology education is a microcosm of the reform and development of the medical education in the Chinese mainland. Hoping to improve the quality of preclinical medical education, the present study was undertaken to present an overview of current status and the changes in physiology education, focusing on course hours, teaching strategies and student assessments, teaching staff in China by conducting a nationwide survey.

A total of 82 responses were finally included in the reports, representing 80 top medical schools. The survey focused on the teaching of clinical medicine students, which usually comprise the largest programs at medical schools. The respondents covered most of the top 100 Chinese medical universities/schools; therefore, the information collected by the survey could represent Chinese medical universities/schools. The results showed that the number of teaching hours spent on physiology at medical schools in China has been significantly reduced, in the past 30 years. In addition, both the quantity and composition of teachers have changed considerably. Traditional didactic teaching is still predominant even though new teaching approaches, including problem-based learning/case-based learning/task-based learning, integrated curriculum and formative evaluation systems have been conducted.

It is well known that small group teaching and exposure to practicals benefit learning, however, the survey showed that both the lecture contact time and laboratory practice hours of physiology in each academic year had decreased in the past 30 decades. Decreased course hours on physiology have occurred worldwide not only in recent times but also in earlier times, both in China and overseas. It has been reported that from 1955–56 to 1985–86, laboratory hours devoted to animal and human physiology declined by 92% [ 24 ]. Consistently, the recent study by Feng et al. also shows that the physiology class hours and the ratio of physiological theory to laboratory have been decreased over the last 20 years [ 21 ]. The reason that physiology class hours are decreased, however, is complicated. At present, an increasing number of students are using internet-based e-learning, such as watching videos. Thus, one important reason for decreased physiology hours is the construction and application of online open courses, which can enable students to learn everywhere at any time by removing temporal-spatial barriers. One other reason for reduced course hours is perhaps to save time for students to do scientific research and for clinic curriculum, which is catering to the demands of modern medical education. The third reason might also be the outcome of educational advancement, that is, the students had been taught some of the physiology knowledge at high schools or even middle schools and there is no need to repeat teaching these knowledge in universities.

Undoubtedly, a high ratio of qualified teachers to students is desirable for medical education. Unfortunately, the survey showed that the total number of teachers in the physiology department had gradually decreased in the past 30 years, in contrast to the rapidly expanding student enrollment [ 25 ]. The recent study by Feng [ 21 ], however, has shown that the total number of physiology teachers remains unchanged rather than decreased. The reason for the difference, however, is still not clear. In the present study, we surveyed the directors of physiology discipline, whereas Feng’s study surveyed the heads or senior teachers. The different survey subjects might affect the survey results.

For the teaching experience of the respondents, the data showed that 98.8% of the respondents had over 5 years of teaching experience and most of them have had a range of 26 to 35 years, even 10 had more than 36 years of teaching experience, demonstrating that the directors have rich experience. There is no doubt that rich teaching experience is good to education. From another perspective, however, this data also suggest that the directors have a relatively old age, and perhaps it is getting difficult for them to accept new teaching strategies. Moreover, consistent with Feng’s study [ 21 ], our results showed that teachers possessing doctor’s degrees has increased, whereas teachers with medical education backgrounds has decreased. There are perhaps two reasons that contribute to these phenomena. First, student enrollment has been greatly expanded in most Chinese medical schools, and it is becoming increasingly difficult for graduates to obtain appropriate jobs. To alleviate employment pressure and improve competitiveness, they must pursue a PhD career. Second, fewer students with medical education backgrounds are willing to pursue a career in the full-time teaching of basic medical sciences [ 2 ], possibly because the income gap has widened further. Third, universities are excessively emphasizing scientific research achievements when recruiting the teaching staff and having a doctoral degree is the most basic requirement for entering the university. The increasing number of teachers with PhD degrees has two sides to physiology teaching. On one side, it helps to cultivate students' scientific research thinking as the teachers have received well training in doing scientific research. On the other side, teachers are often overburdened by spending too much time doing their own scientific research, and therefore, the attention that can be paid to teaching undergraduates will be greatly decreased. Some teachers would even think that teaching is a waste of time, so that the universities have to consider that attending undergraduate courses for a certain amount of time as one of the basic evaluation indicators. The decreasing number of teachers with medical education backgrounds suggest that the physiology teachers have difficulties in connecting with clinical practice during teaching. To ensure the teaching quality, on the one hand, medical schools should help the physiology teachers to cultivate the transforming medical concepts by establishing combined teaching teams between basic and clinic. On the other hand, medical schools should take strategies to reduce the pressure of the teachers from scientific research, so that they are willing to spend more time in teaching.

Every understanding or conclusion of physiology is obtained from practice. Practice also assists students in applying physiology to clinical applications. Regarding explorative practices, 28 schools had adopted them for less than 5 years, 19 for more than 5 years but less than 10 years, 12 for 11–15 years, and only 2 for more than 15 years. 16 schools have not yet adopted explorative practices (Fig. 4 d).

Experimental courses are a very important part of physiology teaching. By conducting experimental courses, students' observation abilities and hands-on abilities can be better cultivated. However, some physiological experiments are time consuming or require expensive equipment. Furthermore, testing variables in physical experiments is difficult. Experiments on live animals also require high levels of biological security. The application of virtual experiments can effectively solve these difficulties by enabling students to experience the experimental process. The survey showed that virtual experiments are adopted by more and more schools, though most schools chose to purchase the virtual experiment sources by the companies. This results indicate that teaching strategies have been greatly impacted by the development of artificial intelligence. A recent study has introduced how to build an electronic standardized patient (ESP) based-virtual human body system powered by the real-time human physiological parameters in the teaching of human physiology. These ESP-based virtual simulation projects presumably becomes a considerable option for the first-class course construction in physiology [ 26 ]. In another study, the effectiveness of virtual labs in practicing biochemical experiments was assessed and the student's feedback regarding this tool was examined, showing that using virtual laboratories is effective in delivering practical parts of basic medical experiments to medical students and that the students have positive attitude toward using virtual laboratories in the practical sessions of a Medical Biochemistry course [ 27 ]. The authors believe that in the future, an increasing number of medical schools will employ combined virtual experiments and traditional experiments, as they can complement each other. Integrating medicine and industry will promote the progress of the medical education.

The high enrollments also raise the question that more students learn in the same class and share one teacher. With reduced teachers and lecture contact time hours, it is thus a challenge for departments to adequately organize teachers to maximize student learning and allow for student-centered teaching approaches. To compensate for the consequences of insufficient offline teaching, online teaching platforms that help to integrate and utilize teaching resources should be vigorously advanced. Currently, MOOCs education platforms such as the Chinese University MOOCs platform, XuetangX online platform, Zhihuishu MOOCs platform, and Chinese MOOC platform have been vigorously developed [ 21 ]. Microlectures are also popular in China. These online learning platforms are of great significance in cultivating students' professional knowledge and enhancing their innovative abilities. However, there are still issues that need to be improved, for example, teachers' online teaching ability needs to be improved, and students' autonomous interest in online learning needs to be stimulated.

For a long time, medical education, requires the medical students first learn basic and biomedical sciences and then move to clinical sciences. It emphasizes one-sideness but lacks the overall concept of medicine, has posed new challenges to the current medical training model and curriculum systems. In addition, the patients are presented in a totally different way as the traditional medical education. Integrated teaching can integrate different disciplines in a unified manner, thereby strengthening students' cognition of disease from different dimensions and levels, which is beneficial for broadening students' vision and reducing repetitive and unnecessary teaching content. It has been proven that the integrated teaching concept centered on organ systems benefits students’ early formation of medical concepts [ 28 , 29 ]. At the time of survey, the majority of the medical schools employed integrated curriculum models. At the time of the survey, integration between physiology and clinical sciences (vertical integration) was reported in more than half of the schools. Integration physiology between other basic medical sciences (horizontal integration) was employed fewer than vertical integration, whereas integration between theoretical lectures and practice sessions was least adopted. These results are consistent with a previous study showing that most curricula for medical education have been integrated horizontally and vertically. Most of the integration was integrated vertically between basic and clinical sciences, yet an vertical integration with humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum is also needed [ 30 ]. Furthermore, most of the schools with integration courses had decreased contact hours in physiology. These results are consistent with previous reports that in a vertically integrated curriculum the time spent on classroom education gradually reduces across the years, while the time on clinical practice increases [ 31 ]. These results also indicate that medical educators have realized that the old curriculum system is not conducive to cultivate systematic clinical thinking patterns, and have already taken steps towards reforms. Reduced classroom hours but enhanced graduation requirement indicated the teaching strategies must be improved. Furthermore, the teaching quality evaluation systems must also be improved. Problem-based learning is an approach that is often used with the aim of creating curricular integration. To improve teaching strategies, PBL, CBL or TBL was implemented in most of the surveyed schools, with more than 5 years of experience.In addition, 46.9% of the schools had tried formative evaluation systems for more than 5 years.

Limitation of this study

Not all the medical schools that provide five-year clinical medicine programs were included in the study, as the sample was not selected randomly.

Conclusions

The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years. Physiology is still mainly taught as a discipline-based curriculum in most medical schools, even though it is integrated with other disciplines. Physiology education in China faces many challenges, such as decreased course hours and decreased teachers with medical backgrounds. Although innovative teaching strategies have been employed in some medical schools, traditional didactic methods are still mostly used. Overall, the present study helps to understand the current status of physiology education in China and raises some concern for the better development of physiology education. Although the sample may not be truly representative of whole China, they were representative of the top 100 medical schools in the mainland of China.

Availability of data and materials

Data and materials can be obtained from the corresponding author upon request.

Abbreviations

Lecture-based learning

Problem-based learning
Case-based learning

Team-based learning

The Chinese Ministry of Education

Science and technology evaluation metrics

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Acknowledgements

The authors would like to thank all of the respondents who completed the survey and enabled this article to be written.

This study was supported by Teaching Reform Project from Guangdong Provincial "New Medical Science" Construction Guidance Committee (2023) and Teaching Quality Project of Sun Yat-sen University (500000–12220011).

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Xuhong Wei and Ting Xu contributed equally to this study.

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Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People’s Republic of China

Xuhong Wei, Ting Xu, Ruixian Guo, Zhi Tan & Wenjun Xin

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X.W. prepared the Figs 1 , 2 , 3 and 4 and Table 1 and 2 and wrote the manuscript. T.X. analyzed the questionnaire and critically revised the manuscript. R.G. tested the questionnaire and revised it. Z.T. and W.X. conceived the study and supervised it.

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Correspondence to Zhi Tan or Wenjun Xin .

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Wei, X., Xu, T., Guo, R. et al. Physiology education in China: the current situation and changes over the past 3 decades. BMC Med Educ 24 , 408 (2024). https://doi.org/10.1186/s12909-024-05395-1

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Comprehensive evaluation of newly cultivated land sustainable utilization at project scale: A case study in Guangdong, China

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Published: 17 April 2024
Volume 34 , pages 745–762, ( 2024 )

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Chang Guo 1 , 2 ,
Xiaobin Jin 1 , 2 , 3 ,
Xuhong Yang 1 , 2 , 3 ,
Weiyi Xu 1 , 2 ,
Rui Sun 1 , 2 &
Yinkang Zhou 1 , 2 , 3

Cultivated land plays a pivotal role in ensuring national food security, particularly in populous nations like China, where substantial investments are made to develop cultivated land as a counterbalance to construction-occupied areas. Consequently, long-term, effective monitoring of the utilization of newly cultivated land becomes imperative. This study introduces a comprehensive monitoring framework, designed for refined scales, that leverages remote sensing data. The framework focuses on the sustainable utilization of newly cultivated land, emphasizing utilization sustainability, productivity stability, and landscape integration. Its effectiveness was validated through a case study in Guangdong province, China. The results revealed satisfactory utilization sustainability and improved productivity stability of newly cultivated land in Guangdong, though landscape integration showed sub-optimal results. Furthermore, the comprehensive evaluation categorized the newly cultivated land into three levels and eight types. The study recommends enhancing the site selection process for newly cultivated land and improving the long-term monitoring, as well as incentive and constraint mechanisms, for their utilization. This study can provide a scientific reference to bolster the implementation of cultivated land protection policies, thereby contributing significantly to high-quality economic and social development.

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Author: Guo Chang, specialized in sustainable land use.

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Guo, C., Jin, X., Yang, X. et al. Comprehensive evaluation of newly cultivated land sustainable utilization at project scale: A case study in Guangdong, China. J. Geogr. Sci. 34 , 745–762 (2024). https://doi.org/10.1007/s11442-024-2225-z

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Received : 19 July 2023

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Issue Date : April 2024

DOI : https://doi.org/10.1007/s11442-024-2225-z

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